Picture Archiving Communication Systems (PACS) initially appeared in 1982 and proliferated in academic radiology departments. Such early system development was eclipsed by the rapid development of computer technology. After 20 years, PACS remain threatened by the frequent releases of computer software, hardware and peripheral advances, and costs. Smart business and healthcare decisions require a team understanding to effectively use PACS to improve patient care, reduced costs and improve the timeliness and accuracy of medical image reading and reporting. Other medical language reporting and patient record privacy and security issues exist to challenge 21st century users. Costs for systems continue to escalate. Literature on PACS is prolific even though few evaluation and marketing studies are available. PACS requires the successful integration of radiology expertise, interactive communication systems, computer programming, marketing and wise business decisions in selecting hardware, software and other vendors. The goal of this G 13 Publication Grant is to prepare a critical review of PACS and address important questions related to future survival in medical imaging. This work forms a critical review and summary of the literature and addresses multiple audiences crucial to continuing PACS development and use. Currently there are more than 6,000 published articles, as well as four books, devoted to specific aspects of the PACS spectrum. Yet, none of these works addresses the whole spectrum for multiple audiences and faces the challenges present for the first decade of the 21St century. This grant would prepare a comprehensive manuscript (and CD-ROM) of issues and background for decision-makers in 350-400 pages over 10 chapters. The project director will benefit from the expertise of 5 expert consultants and an experienced editor.